- 學位論文
敗血症及非敗血症重症病人的發炎反應與其 氧化壓力及抗氧化能力之相關性
Inflammatory responses in relation to oxidative stress and antioxidant capacity in critically septic and non-septic patients
摘要
敗血症重症病人由於處於持續性發炎反應及血液或組織中高細胞激素濃度而造成多重器官衰竭，若能及早確診敗血症的嚴重度及病人的氧化壓力狀況或許能避免臨床狀況之惡化。但是目前針對有無敗血症之重症病人之發炎反應與其氧化壓力狀況及抗氧化能力之相關性的臨床研究甚少。因此本研究目的為比較敗血症及非敗血症重症病人之發炎反應、氧化壓力及抗氧化能力之狀況；評估發炎反應與氧化壓力及抗氧化能力之相關性；探討發炎反應、氧化壓力及抗氧化能力與重症病人之臨床結果的相關性。本研究為前瞻性觀察型研究，研究對象為台中榮民總醫院及彰化基督教醫院外科加護病房的37位重症病人。根據美國胸腔及重症加護醫學會的診斷標準，醫師依照病人進入加護病房後第一天的臨床狀況，將病人分為非敗血症組 (n = 21) 及敗血症組 (n = 16)。記錄病人住加護病房第一天與第七天分別的臨床結果（疾病嚴重度、28天死亡率），測量體位，分析臨床血液生化值、發炎反應指標（C-反應蛋白、介白素-6、腫瘤壞死因子- α）、脂質過氧化程度、總抗氧化能力、超氧化物歧化酶、麩胱甘肽過氧化酶及麩胱甘肽硫轉移酶。雖然兩組病人間的疾病嚴重度及28天死亡率皆無顯著差異，但敗血症組病人脂質過氧化程度顯著高於非敗血症病人，而總抗氧化能力顯著低於非敗血症組病人。在抗氧化酵素活性部分，敗血症組病人其麩胱甘肽硫轉移酶值顯著低於非敗血症組病人。發炎反應、氧化壓力及抗氧化能力狀況應無法在臨床上被用來反應敗血症及非敗血症外科重症病人的臨床結果。
並列摘要
Septic critically ill patients are at particularly high risk of developing multiple organ failure in association with persisting inflammation and high circulating and tissue concentrations of cytokines. Early identification of severity of sepsis and the status of oxidative stress is essential for preventing subsequent or worsening clinical deterioration. However, very few studies explored the relationships of inflammatory responses with oxidative stress and antioxidant capacity in septic and non-septic critically ill patients. The purposes of this study were to compare inflammatory responses, oxidative stress status and antioxidant capacity between critically septic and non-septic patients; to assess the relationship of inflammatory responses with oxidative stress and antioxidant capacities; and to examine the effects of inflammatory responses, oxidative stress and antioxidant capacities on clinical outcomes of critically septic and non-septic critically ill patients. This was a prospective and observational study. Thirty-seven patients were recruited from the surgical intensive care unit (SICU) of Taichung Veteran General Hospital and Changhua Christian Hospital. Patients were allocated into either non-septic group (n = 21) or septic group (n = 16) based on their clinical condition at admission to the SICU. Patients’ disease severity (APACHE II score) , 28 day mortality, anthropometric values, hematological values, inflammatory indicators (i.e., C-reactive protein, interleukin-6, tunor necrosis factor-α ) ,lipid peroxidation indicator (MDA value) , total antioxidative capacity, antioxidant enzyme activities (i.e., superoxide dismutase, glutathione peroxidase, glutathione S-transferase) were recorded or measured at 1st d and 7th d of admission to the SICU. There were no significant differences in severity of illness (APACHE II core) and 28 day mortality between the two groups. However, septic patients had higher lipid peroxidation, lower total antioxidant capacity and glutathione S-transferase levels than did non-septic patients. No significant associations of APACHE II score and 28 day mortality with inflammatory indicators, lipid peroxidation, total antioxidant capacity and antioxidant enzyme activities were observed in septic and non-septic patients. The status of inflammatory response, oxidative stress and antioxidant capacities could not be used to reflect the clinical outcomes of septic and non-septic critically ill surgical patients.